AFM Task Force Report
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Slide 1
AFM Task Force
Co-Chairs: Ruth Lynfield and Jill Taylor
Slide 2
AFM Task Force Membership
View CDC Acute Flaccid Myelitis Task Force Members for full listing
Slide 3
Parents’ Perspectives
- Jeremy Wilcox
- Rachel Scott
- Robin Roberts
Slide 4
Neurologic/Clinical Session
Support for the emergence of novel AFM epidemiology in 2014
- Rapidity of paralysis, epidemiologic pattern of cases and degree of cervical involvement distinguish AFM from other paralytic diseases like transverse myelitis
- Striking biennial, seasonal peaks
- Sporadic cases may have occurred previously, and received other diagnoses
Support for use of sensitive clinical criteria (acute flaccid weakness) for surveillance purposes
- Subsequent analysis of sub-populations
- Sensitive definition will further characterize spectrum of illness
- Specific definition will inform research questions around etiology and pathogenesis
Slide 5
Neurologic/Clinical Session Continued
Understanding MRI lesions can help inform pathogenesis
- The timing of the MRI critical to interpretation of findings
- In patients with only cervical cord affected by MRI, lower extremity weakness due to white matter involvement
- Important to consider treatment modalities for both grey and white matter disease within the cord
Support for rigorous and standardized long term follow-up with strength and functional assessments
Recognize that analysis of treatment outcomes exceedingly difficult with small patient pool and lack of standardized measurements across institutions
Slide 6
Virology & Pathogen Discovery
- Support for link between preceding virus-like illness and AFM
- EV-D68 remains the leading hypothesis for virus trigger despite other EV/RV detections and majority of respiratory specimens negative
- Support for understanding duration of shedding to interpret respiratory specimen results and timing of specimen collection
- Support for improved understanding of enterovirus epidemiology (temporal and geographic) in the US with focus on respiratory disease
- The failure to consistently detect a pathogen in the CSF is likely to remain true even with the planned enhanced discovery methods
Slide 7
Host Immune Response and Immune-mediated Pathogenesis
Support for measuring antibody response to infection in serum and CSF
- Diagnostic (intrathecal), pathogenic antibodies (autoantibodies)
- Antibody-dependent enhancement
Support for broad approaches to measuring pathogen-specific responses
- Multi-pathogen peptide microarrays
- Immune cell receptor repertoire profiling
Support for measuring and characterizing EV-D68 population immunity
Kinetics of disease suggest that antibody-mediated pathology is unlikely
- Low priority given to measuring autoantibody responses
Slide 8
Host Risk Factors
General support for assessing genetic risk factors associated with AFM
Recognition that host genetics studies can be complex and expensive
Target specific gene subsets
- Central nervous system, immune system
- Factors that influence tissue susceptibility: receptor polymorphisms
Support for detailed, structured interviews with families to uncover other potential risk factors
- Environmental, behavioral
Slide 9
Themes That Came Out of the AFM Task Force Meetings
- Important to have strong collaboration encompassing CDC, NIH, expert academic partners and health departments
- Need for understanding CNS damage: direct pathogen effects, immune response
- Non-human primate model and other model systems may be useful
- Continue work on pathogen detection
- Review and summarize clinical phenotypes of cases
Slide 10
Themes That Came Out of the AFM Task Force Meetings, Continued
- Strengthen case identification and surveillance
- Work with partners to optimize recognition of AFM
- Utilize surveillance for risk factor and other studies
- Strengthen and expand education and communication outreach
- Implement natural history study to better understand pathogen(s), pathogenesis and long-term outcomes
- Continue close dialogue with parents and families on a variety of issues
- Medical record interoperability
Slide 11
Questions for BSC
Do you agree with themes?
Any other areas to consider?
Suggestions for ways to increase engagement of clinicians and public health?
Slide 12
Acknowledgements
AFM Task Force Members, Noah Aleshire, Tami Skoff, Manisha Patel, Janell Routh, Adriana Lopez, Kathleen Dooling, Tom Clark, Steve Oberste, Mark Pallansch, William Weldon, Nancy Messonnier, Susan Gerber, Sarah Wiley
Slide 13
Thank You!